Achilles Tendon Rupture

Achilles Tendon Rupture

Article by John Miller

Achilles Tendon Rupture

What is an Achilles Tendon Rupture?

Achilles tendon rupture

What Causes an Achilles Tendon Rupture?

When your Achilles tendon snaps or pops, it is known as Achilles tendon rupture. Often an Achilles tendon rupture can occur spontaneously without any prodromal symptoms. Unfortunately, the first “pop” or “snap” that you experience your Achilles tendon rupture.

Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a basketball pickup game, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often, these are tennis, racquetball, squash, basketball, soccer, softball and badminton.

Achilles rupture can happen in these situations:

  • You make a forceful push-off with your foot while the powerful thigh muscles straighten your knee. One example might be starting a foot race or jumping.
  • You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon.
  • You fall from a significant height.

The most significant risk factor for Achilles tendon rupture is tendon cell death resulting from poorly managed tendinopathy.

Higher Risk of Achilles Tendonitis History

It does appear that any previous history of Achilles tendinopathy results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase Achilles tendon rupture’s risk.

Achilles Tendon Diagnosis

Achilles tendon ruptures misdiagnosis is a staggering 20%-30%. Yet, they shouldn’t be if your healthcare practitioner is methodical and thorough in their assessment. Thompson (calf squeeze) test is 96% sensitive and 93% sensitive. Unfortunately, some health practitioners fail to perform this simple clinical test. An ultrasound examination or an MRI can confirm an Achilles tendon rupture. A palpable “gap” in the Achilles tendon is another positive sign of at least partial rupture.

Please consult your trusted physiotherapist or a sports doctor for a thorough Achilles assessment.

Ruptured Achilles Tendon Treatment

Treatment of a ruptured Achilles tendon is usually conservative (non-operative) in a Controlled Motion Ankle (CAM) Boot, or it may require surgery. Your decision should involve a conversation with your ankle surgeon.  The current consensus based on research is to treat them conservatively since the functional outcome and chance of re-rupture is similar (7% to 15%) using both approaches. Surgical intervention has a higher risk of infection.

Achilles tendon surgery is more likely if your Achilles has re-ruptured or there is a delay of two weeks between the rupture and the diagnosis and commencement of conservative bracing and treatment.

Post-Achilles Repair Physiotherapy

Most surgeons will recommend that you commence physiotherapy about one week post-op. It is vital to not over-stress your Achilles tendon repair. We recommend the professional guidance of a physiotherapist experienced in Achilles tendon rupture rehabilitation for your best outcome.

Ruptured Achilles Tendon Prognosis

You will typically be in your CAM brace for between 6 to 12 weeks. If everything goes perfectly during your rehabilitation, it takes at least 12 weeks before considering any graduated return to sport program. This timing is, of course, at the discretion of your Achilles surgeon. However, some Achilles tendon repairs can take six to 12 months to rehabilitate successfully and return to sport if there are complications.

Seek Professional Advice

The best advice is to seek early advice from your physiotherapist, doctor or orthopaedic surgeon. Delay does result in a poorer prognosis.

If you are lucky, you may avoid surgery but require a walking boot, or similar, with a graduated rehabilitation program to strengthen your injured tendon and prevent a further injury.

FAQs about Achilles Tendon Rupture

sports injury

Sports Injury Management

You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary significantly to how we treat you this year. The good news is that you can benefit considerably from our knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving, or other problems will develop.

Ice or Heat?

We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.

Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.

Should You Use a Compressive Bandage?

Yes. A compressive bandage will help to control swelling and bleeding in the first few days.  In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support such as a brace or strapping tape. Please ask us if you are uncertain about what to do next.

Elevation?

Gravity will encourage swelling to settle at the lowest point.  Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries.  Think where your damage is and where your heart is. Try to rest your injury above your heart.

What Medication Should You Use?

Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek their professional advice as certain medications can interfere with other health conditions, especially asthmatics.

When Should You Commence Physio?

In most cases, "the early bird gets the worm".  Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits.  These include:

  • Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
  • Improving your scar tissue using techniques to guide the direction it forms
  • Getting you back to sport or work quicker through faster healing rates
  • Loosening or strengthening of your injured region with individually prescribed exercises
  • Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.

What If You Do Nothing?

Research tells us that injuries left untreated take longer to heal and have lingering pain.  They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your symptoms, the better your outcome.

What About Arthritis?

Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:

  • An inappropriately treated previous injury (e.g. old joint or ligament sprains)
  • Poor joint positioning (biomechanical faults)
  • Stiff joints (lack of movement diminishes joint nutrition)
  • Loose joints (excessive sloppiness causes joint damage through poor control)

What About Your Return to Sport?

Your physiotherapist will guide you safely back to the level of sport at which you wish to participate.  If you need guidance, ask us.

What If You Need Surgery or X-rays?

Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury.  Please use our advice to guide you out of pain quicker. And for a lot longer.

If you have any questions regarding your sports injury (or any other condition), please contact your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.